Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, PR China.
Arch Med Res. 2012 Feb;43(2):132-8. doi: 10.1016/j.arcmed.2012.02.002. Epub 2012 Feb 29.
Lymphatic microvessel density (LMVD) has been demonstrated to correlate with tumor metastasis. The purpose of this study is to determine whether the criteria combining LMVD with computed tomography (CT) could improve the diagnostic accuracy of lymph node (LN) metastasis in non-small cell lung cancer (NSCLC).
Ninety four patients with NSCLC who had chest CT scans preoperatively and LMVD tested by immunohistochemistry postoperatively were randomized into two groups: the training set (n = 66) and the test set (n = 28). Cut-off point of LMVD was selected to separate the LN metastasis-predictive positive and negative groups. On the basis of LMVD levels, chest CTs of the training set were re-analyzed and hypothetical criteria for LN metastasis diagnosis were established. Diagnostic characteristics for LN metastasis were tested by using the combined criteria in the test set as compared to those of CT alone.
There was a significantly positive correlation between LMVD and LN metastasis (p <0.01). For sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV), accuracy was 67, 81, 75, 81 and 79% for the combined criteria, respectively. Diagnostic efficacy of the combined criteria was significantly higher than that of CT only (p <0.05).
Diagnosis of LN metastasis using a combination of LMVD and CT is superior to the CT-only diagnosis. In future clinical trials, it is necessary to evaluate the efficacy of adjuvant therapy for the selection of patients according to the combined criteria.
淋巴管微血管密度（LMVD）已被证实与肿瘤转移相关。本研究旨在确定将 LMVD 与计算机断层扫描（CT）相结合的标准是否可以提高非小细胞肺癌（NSCLC）淋巴结（LN）转移的诊断准确性。
94 例 NSCLC 患者术前均行胸部 CT 扫描，术后行免疫组化检测 LMVD，将患者随机分为两组：训练集（n=66）和测试集（n=28）。选择 LMVD 的截止值将 LN 转移预测阳性和阴性组分开。基于 LMVD 水平，重新分析训练集的 CT 图像，并建立 LN 转移诊断的假设标准。使用测试集中的联合标准对 LN 转移进行诊断，与单独使用 CT 进行诊断的特征进行比较。
LMVD 与 LN 转移之间存在显著的正相关（p<0.01）。对于联合标准的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），准确性分别为 67%、81%、75%、81%和 79%。联合标准的诊断效果明显优于 CT 单独诊断（p<0.05）。
使用 LMVD 和 CT 联合诊断 LN 转移优于 CT 单独诊断。在未来的临床试验中，有必要根据联合标准评估辅助治疗对患者选择的疗效。
